Diabetic Foot Ulcers Flashcards
herring
Mild infections are …
local infection w/o involvement of deeper tissues AND no systemic signs of infection
if erythema is present, its < 2 cm
moderate infections are …
local infection w erythema > 2 cm or infection involving deeper structure AND no systemic signs of infection
severe infections are…
local infection w systemic sx of infection, metabolic disturbances (acidosis, severe hyperglycemia, new onset azotemia) or critical ischemia
What bacteria are common in diabetic foot infections
gram positive: staph/strep (skin)
gram negative: e. coli
anaerobes
pseudomonas
what are risk factors of pseudomonas
not responding to non-pseudomonal therapy
macerated ulcers
foot soaking or other significant exposure to water
known pseudomonas colonization within 1 year
what do IDSA guidelines recommend with empiric tx w antipseudomonal agents for DFI
they are AGAINST emperic tx w antipseudomonal agents
empiric Abx therapy (mercy answer)
ceftriaxone 1-2 g q24h OR cefazolin 1-2g q8h
PLUS
vanco 15-20 mg/kg q12h
Trough 10-15 (no osteo worries) before 4th dose or AUC:MIC ratio 400
empiric Abx therapy (UIHC answer)
ceftriaxone 1 g QD PLUS
vanco 15 mg/kg q12h PLUS
metronidazole 500-750 mg q6-8h
what are the 2 methods of monitoring vanco dosing
AUC:MIC ratio
Trough monitoring
which is safer and why:
AUC:MIC ratio vs Trough monitoring
AUC is safer
associated w less nephrotoxicity though AUC target of >600 has been associated w nephrotoxicity
who still uses trough based dosing
peds (<18 yo)
patients on RRT (HD, peritoneal dialysis, CRRT)
home care patients
why is AUC not used in certain populations that need trough based dosing
peds: want to avoid multiple sticks, PK is different in peds than adults
renal patients: cannot accurately predict AUC
home care: more difficult to obtain 2 levels timed appropriately in outpatient setting
what conditions/infections use the AUC standard intensity dosing
target: 400
cellulitis, intra-abdominal, soft tissue, diabetic foot, febrile neutropenia, surgical ppx
what conditions/infections use the AUC critically ill or serious MRSA infection dosing
target: 600
severe sepsis/septic shock, pneumonia, osteomyelitis, endocarditis, meningitis
what conditions/infections monitor vanco dosing with trough
target: 10-15 mcg/ml
SSTI
UTI
intra-abdominal infections
